The term “thoracic outlet” describes an area at the base of your neck, just above your collarbone. Some important nerves and vessels pass through this outlet on their way into your arm. Compression of these tissues causes a condition called “thoracic outlet syndrome” which results in pain, numbness or tingling in your arm.

Several different factors can cause Thoracic Outlet Syndrome, commonly referred to as TOS. Sometimes TOS is caused from tightness in the muscles of your neck and chest, other times the space between your first rib and collarbone is too small. People who have an extra rib (cervical rib) and people who have recently suffered a neck injury may have a greater chance of having this problem.

The condition is aggravated by poor posture and by occupations that promote “slouching,” i.e., computer users, assembly line workers, supermarket checkers and students. Swimmers, volleyball players, tennis players, baseball pitchers and occupations requiring prolonged overhead activity. i.e., electricians and painters are also prime candidates for TOS.

ymptoms of TOS include arm pain, numbness, tingling and possible weakness. Neck, arm and hand pain may begin slowly and are often aggravated by elevation of the arms or excessive head movement. Loss of grip strength is possible.

Conservative treatment, like the kind we provide, has been shown to be effective at treating TOS. Through our careful exam we have identified your specific sites of compression and will use some of the following treatment to help:

You should avoid carrying heavy loads, especially on your shoulder i.e., carpet rolls. Briefcases, laptop cases or heavy shoulder bags should be lightened. Bra straps may need additional padding or consideration of replacement with a sports bra.


Here is a brief description of the treatments we may use to help manage your problem.

Joint Manipulation

Joint Manipulation

Your chiropractor has found joints in your body that are not moving freely. This can cause tightness and discomfort and can accelerate unwanted degeneration i.e. arthritis. Your chiropractor will apply a gentle force with their hands, or with hand held instruments, in order to restore motion to any “restricted” joints. Sometimes a specialized table will be used to assist with these safe and effective “adjustments”. Joint manipulation improves flexibility, relieves pain and helps maintain healthy joints.

 

Therapy Modalities

Therapy Modalities

We may apply electrotherapy modalities that produce light electrical pulses transmitted through electrodes placed over your specific sites of concern. These comfortable modalities work to decrease your pain, limit inflammation and ease muscle spasm. Hot or cold packs are often used in conjunction, to enhance the effect of these modalities. Another available option is therapeutic ultrasound. Ultrasound pushes sound vibrations into tissues. When these vibrations reach your deep tissues, heat develops and unwanted waste products are dispersed.

 

Myofascial Release

Myofascial Release

Overworked muscles often become tight and develop knots or “trigger points”. Chronic tightness produces inflammation and swelling that ultimately leads to the formation of “adhesions” between tissues. Your chiropractor will apply pressure with their hands, or with specialized tools, in order to release muscle tightness and soft-tissue adhesions. This will help to improve your circulation, relieve pain and restore flexibility.

 

Therapeutic Exercise

Therapeutic Exercise

Muscle tightness or weakness causes discomfort and alters normal joint function, leading to additional problems. Your chiropractor will target tight or weak muscles with specific therapeutic stretching and strengthening to help increase tissue flexibility, build strength, and ease pain. Healthy, strong, and flexible muscles may help prevent re-injury.

 

 

 

After this initial course of treatment we will reassess your progress. We will determine the need for any additional care after your reassessment.

Pillow Selection

Pillow Selection

To avoid neck and upper back pain from improper neck support:

  • Select a pillow that will hold your head in a neutral position while sleeping on your side or back.
  • 
Avoid excessively thick or multiple pillows.
  • 
Choose a fiberfill or feather/down pillow as these are usually better than foam.
  • Consider a commercially available pillow that promotes good neck posture.
 

Workstation Ergonomics

Workstation Ergonomics

Ergonomics is the science of adjusting your workstation to minimize strain in the following ways:

  • Wrists should not be bent while at the keyboard. Forearms and wrists should not be leaning on a hard edge.
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Use audio equipment that keeps you from bending your neck (i.e., Bluetooth, speakerphones, headsets).
  • Monitors should be visible without leaning or straining and the top line of type should be 15 degrees below eye level.
  • Use a lumber roll for lower back support.
  • Avoid sitting on anything that would create an imbalance or uneven pressure (like your wallet).
  • Take a 10-second break every 20 minutes: Micro activities include: standing, walking, or moving your head in a “plus sign” fashion.
  • Periodically, perform the “Brugger relief position” -Position your body at the chair’s edge, feet pointed outward. Weight should be on your legs and your abdomen should be relaxed. Tilt your pelvis forward, lift your sternum, arch your back, drop your arms, and roll out your palms while squeezing your shoulders together. Take a few deep cleansing breaths.
 
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